Healthcare Provider Details

I. General information

NPI: 1043427230
Provider Name (Legal Business Name): MARION PEDIATRICS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 HUTTLESTON AVE
FAIRHAVEN MA
02719-5630
US

IV. Provider business mailing address

404 HUTTLESTON AVE
FAIRHAVEN MA
02719-5630
US

V. Phone/Fax

Practice location:
  • Phone: 508-996-9333
  • Fax:
Mailing address:
  • Phone: 508-996-9333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE CHURCH
Title or Position: BILLING MANAGER
Credential:
Phone: 508-996-9333